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WE SH IP TO ALGERI A VIE W D E TAILS

Elbow Pain? 6 Tips for Training Around

Cranky Elbows

Elbow pain holding you back from making the gains you want?
Read this article for 6 helpful tips on recovering from and
training around cranky elbows.

It’s Monday and if you’re like most testosterone raging males, that means bench press
and lots of it.
However, elbow pain can easily put a damper on your pec pumping party.

Here’s how to get your mojo back…

Joint by Joint Approach

The elbow is essentially the knee of the upper body. It’s routinely blamed for being
problematic but often it’s merely an accomplice to the crime rather than the main
perpetrator.

If we examine the biomechanics of the upper body via the joint-by-joint approach (ala
Mike Boyle and Gray Cook), we can see that certain joints need stability, mobility, or
perhaps a combination of both:

Foot - Mobility & Stability

Ankle - Mobility
Knee - Stability
Hip - Mobility & Stability
Lumbar Spine - Stability
Thoracic Spine - Mobility
Scapula - Mobility & Stability
Shoulder - Mobility & Stability
Elbow - Mobility
Wrist - Mobility

Related: Train Like An Athlete, Look Like A Bodybuilder

In the case of the elbows, they are often forced to bear the brunt of the load from the
wrist and shoulder.

For example, if the shoulder lacks mobility and you may have to compensate through the
elbow to complete the movement. Now you wind up with elbow pain and get stuck
investigating a false positive while the shoulder continues to remain the real issue.
Programming by the Pros
Please keep in mind that pain is not always indicative of musculoskeletal dysfunction at a
cellular level. Relax tough guy, just because you wake up with elbow pain doesn’t mean
you magically procured ulnar nerve entrapment overnight. As I touched upon in a
previous article:

“The human body is an incredibly adaptive organism with multiple degrees

of freedom so it is very tough to make declarative statements regarding static
or dynamic postures.
If posture and pain were really as simple as folks make them out to be, then
why have multiple studies confirmed that 20-70% of patients with
“anatomical abnormalities” (i.e. disc bulges/herniations, labral tears, spinal

stenosis, meniscal tears, etc.), present with no history of pain?3-5”

So, given that’s the case, we should first look at programming and technique
modifications before resorting to soft tissue or even supplemental recommendations to
combat inflammation.

1. Utilize a Neutral Grip For Pressing AND

Pulling
This is standard practice for elbow pain but folks often forgot about both sides of the
equation. Ideally, we want to eliminate fully supinated or pronated movements when
possible to limit rotational stress at the elbow.

For example, if you choose to utilize neutral grip DB presses, don’t forget to also
incorporate neutral grip chin-ups and DB rows. Here’s just a few suggestions to
incorporate into your programming for 6-8 weeks in place of your normal compound
movements.

SQUAT:
Safety Bar Squat
High Bar Squat (Instead of low bar)
Front squat with straps
Front squat with arms crossed

HINGE:
Trap Bar Deadlift
Trap Bar RDL
DB RDL

PUSH (Horizontal):
Neutral Grip DB Press
Swiss Bar Bench Press
Pushup Variations
DB Floor Press

PUSH (Vertical):
Trap Bar OHP
Neutral Grip DB Press

PULL (Horizontal):
Neutral Grip DB Row
V-Bar Cable Row (Wide and Narrow)

PULL (Vertical):
Neutral Grip Chinup
V-Bar Pulldown (Wide and Narrow)

LUNGE:
Utilize DB or trap bar variations
GUN SHOW (Flexion):
Swiss Bar Curl
DB Hammer Curl
Cable Rope Hammer Curl
Banded Hammer Curl

GUN SHOW (Extension):

Swiss Bar Tricep Extension
DB Tricep Extension
Cable Rope Extension
Banded Tricep Extension

If you don’t have access to DBs or a Swiss bar, make sure to situate the bar as low as
possible in the palm. This will help to keep the wrist stacked over the elbow and take
some of the isometric stress off the forearm flexors. Greg Robins does an excellent job
explaining the concept in more depth here:

EricCressey.com - Bench Press Technique: Setting Up Your Grip

2. Consider Using Straps or Modify Your Grip

Elbow issues can indeed be indicative of a weak grip but they can also be the result of
overcompensation. For example, when performing chin-ups, many folks will end up
flexing the wrist to assist in pulling their chin over their bar.

If that’s the case, the forearm is now loaded with the entire weight of the body during the
eccentric component of the movement and this can potentially lead to tendinitis
(inflammation from micro-tears due to acute overloading) or tendinosis (degeneration of
collagen due to chronic overuse).6

If you tend to overuse your forearms during pulling movements, you may want to
consider utilizing a thumbless grip. Generally, this can help to clean up technique as the
individual is forced to use more of the back musculature rather than driving the
movement with the arms. But, this can also add additional stress to the forearm as the
wrist flexors bear more of the load.

If you experience more pain on the medial (inner) portion of the elbow then
straps are likely your best option. However, if more of the pain is located on
the lateral (outer) portion of the elbow then a thumbless grip may be a viable
solution.

If you do choose to use straps with any of the pulling variations listed above, ensure that
the movement takes place primarily at the elbow and shoulder, not the wrist. On top of
that, you may want to consider performing heavy hinge and lunge movements (see
above) without straps and adding additional farmers walks to address grip issues.

3. Utilize Irradiation
Irradiation is a big, fancy word which basically means that stability within joints of the
upper body is generally governed by how hard you squeeze something.
Dr. Roger Enoka breaks it down in the Neuromechanics of Human Movement as, “the
spread of muscle activation that augments postural stability and enables the transfer of
power across joints by two-joint muscles.”1 For example, the triceps accomplish this in
the shoulder and the elbow as they are a biarticular muscle group.

This flies in the face of point #2 but you may need to experiment a bit and see what
works for you. If your elbow issues stem from instability at the shoulder or wrist, some
additional irradiation through grip strength and neural drive during the movement (i.e.
SQUEEZE!) may prove to be a simple solution.

For others, they may find that straps are a lifesaver for any movement which tractions the
wrist (e.g. DB rows). This list isn’t a set of hard and fast rules, as Bruce Lee once said:

“Absorb what is useful, discard what is useless and add what is specifically
your own.”

4. Don’t Over Cue

Many lifters like to use the cue, “screw your arms into your sockets” or “bend the bar” for
pressing and pulling movements alike. While the idea is a good one, it can be overused.
Elbow issues largely stem from one of two issues:

Rotation
Flexion/Extension of the Wrist

Given that’s the case, if you have elbow issues, you want to limit both whenever possible.
So, in the case of this cue, you may need to regress the movement entirely or perhaps
just change your cueing. Limit additional rotational stress at the elbow and focus more
on point #3 above (irradiation). Squeeze instead of twist and see how your elbow feels.
5. Ditch Low Bar Squats and Keep Your Grip
Loose
I know, I know, all the Starting Strength aficionados are having a mild panic attack after
reading that. Listen, put down your gallon of milk for a second and hear me out…

Due to the difference in bar position, many lifters experience elbow issues if they lack the
requisite external rotation at the shoulder. Thus, the elbow experiences an exceptionally
high amount of torque and this presents as pain at the medial epicondyle.

If you talk to most high bar squatters, you’ll find that many of them never experience any
elbow issues. Why? A simple change in bar position and torso angle relative to the
elbow. Nothing wrong with either lift but if you’re dealing with elbow pain it may be time
to put your ego aside and switch things up.

Related: Squatting Made Simple - 5 Tweaks That Work Every Time

Not only that, widening and loosening your grip will free up even more stress from the
elbow. Use just enough tension to keep the bar in place but nothing more; save that
extra tension for when you hit a sticking point.

You’ll find that this not only helps to improve stability through the trunk (ala irradiation
which we discussed above), it also aids in force transfer from the lower body.

6. Soft Tissue Work

Remember, this should be your last-ditch effort. Programming modifications first and
foremost, then consider soft tissue solutions.

As I mentioned above, the elbow is often caught in a tug of war between the wrist and
shoulder. Given that’s the case, we need to address the musculoskeletal structures
present both above and below the offending joint.

Here are some ideas to get you started:

Triceps

FIX YOUR FRONT SQUAT: Addressing the Triceps

Pecs
Forearms

FIX YOUR FRONT SQUAT: Addressing the Forearms

NSAIDs
“My elbow has been hurting for a while, can’t I just pop some Aleve and get back under
the bar?”

I mean yeah, you could, but you’d be doing more harm than good in the long run. I’ve
touched on NSAIDs in the past but I’ll quote it here for those who may have missed it:

“NSAIDs can profoundly alter the basic model of tissue repair by reducing

the production of prostaglandins.2 This essentially shortcuts step #1 in the

process (inflammation > proliferation > remodeling) as prostaglandins are
very important for both the promotion and resolution of the inflammation

pathway.3
Not only that, there have been a number of studies linking NSAIDs to various
issues such as increased joint laxity, non-union fractures, and decreased

tendon strength.4,5”

Movement is medicine, don’t simply resort to pharmaceutical “crutches” without

addressing the root of the issue. There is no magic bullet or cure all which will magically
fix your elbow overnight.

However, if you apply a variety of solutions from this article and give it time, I think you’ll
be pleasantly surprised with the results.
references
1. Enoka R. Neuromechanics of Human Movement. 5th ed. Champaign, IL: Human Kinetics; 2015.
2. [NSAID and its effect on prostaglandin].
3. Prostaglandins and Inflammation
4. Nonsteroidal anti-inflammatory drugs' impact on nonunion and infection rates in long-bone fractures.
5. NSAID therapy effects on healing of bone, tendon, and the enthesis
6. Tendinopathy: Why the Difference Between Tendinitis and Tendinosis Matters

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About The Author

Mike Wines
Mike received his B.S. in Exercise Science from USC and his Masters in
Exercise Physiology and Sport Performance at ETSU while studying under
the head of sport biomechanics for the Olympic training site at ETSU.
View all by Mike Wines »

5 Comments + Post Comment

Posted Sat, 03/31/2018 - 20:48 LIKE 1

Scotty
I have recently returned to the weights room after a 9 month layoff, due to tendonitis in both
elbows. This was due to work, as I have worked as a baker for the last 17 years, which
obviously put extreme stress through both my elbows and wrists. I'm easing myself back into it
with a full-body workout and so far, so good. I'm definitely gonna use some of these
techniques, though as a preventative measure.

REPLY
REPLY

Posted Sun, 12/24/2017 - 11:27 LIKE 1

James
Thanks Mike, Will definitely give these a try. Heavy bench and low bar squats have given me
some serious pain in the bicep tendon and flexors.

REPLY
REPLY

Posted Thu, 07/13/2017 - 20:39 LIKE 3

Kim
Battling this right now. Will try the tips tomorrow .
 REPLY
REPLY

Posted Fri, 06/16/2017 - 01:31 LIKE 3

Thami
Thanks so much for this article. Am already seeing improvements and a marked decrease of
pain in my elbow!

REPLY
REPLY

Posted Wed, 06/14/2017 - 22:02 LIKE 3

Rod Elliott-Mullens
Best article I have seen in a while. At least I know I am not alone with my elbow pain!!!!

REPLY
REPLY

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